甲状腺激素在心梗后心衰中的作用进展

Advances in the Role of Thyroid Hormones in Heart Failure after Myocardial Infarction

摘要: 冠状动脉疾病是世界范围内致残和死亡的主要原因之一，冠心病的再灌注治疗和药物治疗成功地降低了主要不良心脏事件的发生率和全因死亡率。然而，冠心病患者在初次发作后仍有发生心血管事件的重大风险。因此，对冠心病患者进行个体化风险预测，以识别预后不良的冠心病患者，对优化高危患者的预后具有重要意义。心肌梗死(MI, Myocardial Infarction)是心血管疾病患者心衰的主要原因，随着冠心病发病率的逐年上升，心力衰竭患者逐年增加，慢性心力衰竭患者的年度死亡率高达60%。心血管系统是甲状腺激素作用的重要靶器官，在心肌梗死、心力衰竭等重大疾病的发展及预后中甲状腺激素起着关键性的作用。fT3作为主要的生物活性激素，通过基因组和非基因组途径，在提高心率和心脏收缩力以及降低全身血管阻力方面发挥重要作用，在严重的心血管疾病中，多种因素导致周围循环中T4向T3转化减少，从而导致低血清T3浓度。越来越多的研究表明，血清T3的降低与左心室功能不良有关，并作为慢性心力衰竭(CHF, Chronic heart failure)患者预后的一个强有力的预测因子。本文综述了甲状腺激素在心梗后心衰中的作用进展，希望为心梗后心衰的治疗提供新的方向。

Abstract: Coronary artery disease is one of the leading causes of disability and death worldwide, and reperfusion therapy and pharmacotherapy of coronary artery disease have successfully reduced the incidence of major adverse cardiac events and all-cause mortality. Therefore, individualized risk prediction for CHD patients to identify CHD patients with poor prognosis is of great significance to optimize the prognosis of high-risk patients. Myocardial Infarction (MI) is the leading cause of heart failure in patients with cardiovascular disease. With the increasing incidence of coronary heart disease and heart failure, the annual mortality rate of patients with chronic heart failure is as high as 60%. Cardiovascular system is an important target organ of thyroid hormone, which plays a key role in the development and prognosis of myocardial infarction, heart failure and other major diseases. As a major bioactive hormone, FT3 plays an important role in increasing heart rate and cardiac systolic force and reducing systemic vascular resistance through genomic and non-genomic pathways. In severe cardiovascular diseases, a variety of factors lead to reduced T4 to T3 conversion in the peripheral circulation, resulting in low serum T3 concentration. A growing body of research has shown that decreased serum T3 is associated with left ventricular dysfunction and is a strong predictor of prognosis in patients with chronic heart failure (CHF). In this paper, the role of thyroid hormone in heart failure after myocardial infarction is reviewed, hoping to provide a new direction for the treatment of heart failure after myocardial infarction.